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Poster Session E - Tuesday Afternoon

Category: Interventional Endoscopy

E0435 - Real World Outcomes of Transoral Incisionless Fundoplication at a Tertiary Academic Center

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Robert L. Pecha, MD

Baylor College of Medicine
Houston, TX

Robert L. Pecha, MD, Tara Keihanian, MD, Margarita Riojas Barrett, , Kalpesh K. Patel, MD
Baylor College of Medicine, Houston, TX

Introduction: Transoral incisionless fundoplication (TIF) is a minimally invasive procedure for treatment of gastroesophageal reflux disease (GERD). Although studies have reported long-term durability and resolution of symptoms, the procedure carries a wide range of adverse events from mild to life-threatening. This study aims to evaluate the short-term outcomes of consecutive TIF procedures in a tertiary academic center.

Methods: This is a retrospective study of patients who underwent TIF procedure by a single experienced gastroenterologist at a tertiary center in the United States from January 2018 to December 2021. Clinical success was defined as the ability to create a >=270° partial wrap with estimated longitudinal length of >=2cm. Short-term outcomes including patient symptoms or procedure related adverse events immediately to two months post-op were collected retrospectively.

Results: Overall, 68 patients underwent 77 consecutive TIF procedures. The average age of patients was 52.35 ± 15.74 years (67.6% female). Technical success was achieved in 100% of the patients. 10.3% of the patients had a history of prior anti-reflux surgery. Chronic GERD was the main indication for TIF procedure. The majority of patients underwent TIF for Hill grade II and III flap valves, present in 62.5% and 25%, respectively. 50.6% of patients had post-procedure symptoms up to 2 months post-procedure including abdominal pain (28%), nausea/vomiting (14.3%), chest pain (10.4%), dysphagia/odynophagia (6.5%). There was a positive correlation between number of fasteners used and immediate abdominal pain (p=0.003), sore throat (p=0.024), and nausea/vomiting (p=0.046). Two patients developed major adverse events: one developed pneumoperitoneum and the second aspiration pneumonia complicated by flash pulmonary edema. Of the 29 patients with follow-up EGDs, 62.1% had an intact wrap (Hill I). There was no significant difference in the average number of fasteners in those with intact or loose wrap on follow up EGD (21.67 ± 5.1 vs. 22.8 ± 5.2, p=0.57). 9 patients (13.2%) underwent redo TIF and 2 (2.9%) proceeded with surgical fundoplication for persistent symptoms.

Discussion: Outcomes of TIF performed on a heterogeneous population in a tertiary academic center are comparable to outcomes reported from original randomized trials of TIF. Immediate adverse effects are common after TIF, but typically improve on long-term follow-up.

Patient summary characteristics:

Gender (Female)

Age [mean ± SD]

Race

White

Non-Hispanic

BMI [mean ± SD]

ASA Score

III

Prior history of Barrett’s ablation

Prior esophageal surgical intervention

Nissen Fundoplication

POEM- Nissen Fundoplication

POEM

Indication for TIF

GERD

Chronic cough +/- GERD

Hernia HILL grade (if available):

PH impedance or Bravo test (uninterpretable (n=1); not

performed due to presence of BE/esophagitis (n=5))

Acid

Non-acid

67.6% (n=46)

52.35 ± 15.74

79.41% (n=54)

67.65% (n=46)

27.7 ± 5.1

69.1% (n=47)

29.4% (n=20)

1.5% (n=1)

4.4% (n=3)

8.8% (n=6)

1.5% (n=1)

2.9% (n=2)

83.82% (n=57)

16.17% (n=11)

25% (n=14)

62.5% (n=35)

8.9% (n=5)

3.6% (n=1)

82.26% (n=51)

17.74% (n=11)

Procedure characteristics:

Number of fasteners [mean ± SD]

Median Hospital LOS (days) [min, max]

23.1 ± 6.2

1 [0,10]

Immediate outcomes post procedure-2 months(%):

Immediate adverse events

Immediate abdominal pain

Immediate chest pain

Immediate dysphagia/odynophagia

Immediate sore throat

Immediate Nausea/vomiting

Follow-up Procedural outcomes (%):

Post-TIF EGD performed

Time interval between TIF and Follow up EGD

Esophagitis on post-TIF EGD

Intact wrap on post-TIF EGD

>95% SAP on follow up PH testing (out of 18)

Post-TIF surgical fundoplication (n)

50.6% (n=39)

28.6% (n=22)

10.4% (n=8)

6.5% (n=5)

7.8% (n=6)

14.3% (n=11)

42.6% (n=29)

269.8 ± 205.1 Days

10.3% (n=3)

62.1% (n=18)

50% (n=9)

2.9% (n=2)

Repeat TIF patient characteristics:

Repeat TIF required (n)

Female Gender (%)

BMI at initial TIF [mean ± SD]

Age at initial TIF (median) [min,max]

ASA score at initial TIF (median) [min,max]

Number of fasteners (median) [min, max]

Initial TIF

Re-Do TIF

Procedure length (median) [min, max]

Initial TIF

Re-Do TIF

13.2% (n=9)

66.7% (n=6)

29.4 ± 3.7

53 [25,65]

2 [2,3]

20 [14,34]

22 [8,28]

47 [36,89]

45 [29,56]

Table: Baseline patient characteristics and short-term post-TIF outcomes

Disclosures:

Robert Pecha indicated no relevant financial relationships.

Tara Keihanian indicated no relevant financial relationships.

Margarita Riojas Barrett indicated no relevant financial relationships.

Kalpesh Patel: Boston Scientific – Consultant.

Robert L. Pecha, MD, Tara Keihanian, MD, Margarita Riojas Barrett, , Kalpesh K. Patel, MD. E0435 - Real World Outcomes of Transoral Incisionless Fundoplication at a Tertiary Academic Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.